Heart Foundation grant supports rural chest-pain trial

A Heart Foundation grant part-funded the pilot study of a new chest-pain assessment process in rural Waikato, which recently received a Cardiac Society of Australia and New Zealand (CSANZ) award.

Developed by Pinnacle Midlands Health Network (Pinnacle MHN), the rural chest-pain assessment method, referred to as a pathway, sees low-risk patients in rural communities safely assessed and managed by their general practice, rather than travelling long distances to hospital – often needlessly.

At the presentation of the pilot findings at a recent CSANZ meeting, lead researcher and Pinnacle project manager, Tim Norman was awarded the Affiliate’s Prize.

“This award recognises that the pathway could provide a change to the chest-pain model of care,” says Tim.

“This is an example of integration with hospitals, where we equip and fund general practice to complete the care of patient closer to home, referring to hospital when appropriate. The many benefits for the patient being treated closer to home are obvious.”

Preliminary results demonstrate the success of the programme in managing low-risk chest pain in general practice. The project ran for 18 months and collected data from 205 patients.

More than 58 per cent of patients in the trial group, who would otherwise have been referred to an emergency department, were treated in a general practice. One hundred per cent of the low-risk patients did not re-present to an emergency department or have a major acute coronary event, such as a heart attack, within 30 days.

Programme aims

The aim of the programme was to equip general practice with a risk stratification tool, a time-saving diagnostic blood test referred to as ‘point of care troponin’ (POCT), and funded clinical time to identify and manage low-risk patients in general practice.

“We believe this is a first of its kind in general practice – nationally and internationally,” says Tim.

“Our hospital partners have been using the chest pain risk stratification tool (Emergency Department Assessment of Chest Pain Score, known as EDACS) for a number years, based on the work completed by Dr Martin Than, a Christchurch ED physician considered a lead expert in this area.”

Dr Than’s work was also supported by a Heart Foundation project grant in 2011.

The pathway was run as a proof of concept and kicked off in October 2016. It included the introduction of the chest pain assessment tool and point of care machine into 12 participating rural GP practices across the Waikato region.

The proof of concept officially ended 30 April, 2018 and was also part-funded by the Waikato Medical Research Foundation.

Where to now?

“Although the proof of concept has been achieved and has formally ended, the local DHB has agreed to continue sponsoring the existing practices until a business model can be addressed,” says Tim.

“We are working towards national endorsement, national policy and national registry by expanding the primary care programme in the midland region, including rural and urban practices and into all rural hospital settings.”

Practices in Tairāwhiti are the next to come on board, with a training evening attended by 30 people representing Gisborne practices.